Comparison of Five-Year Outcomes of Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention in Patients With Left Ventricular Ejection Fractions ≤50% Versus &gt;50% (from the CREDO-Kyoto PCI/CABG Registry Cohort-2)

Marui, Akira; Kimura, Takeshi; Nishiwaki, Noboru; Mitsudo, Kazuaki; Komiya, Tatsuhiko; Hanyu, Michiya; Shiomi, Hiroki; Tanaka, Shiro; Sakata, Ryuzo

doi:10.1016/j.amjcard.2014.07.007

Cited by 61 publications

(51 citation statements)

References 25 publications

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“…24) To explain this contradiction, there are several confounding factors regarding the association between CABG and LVEF improvement in the present study. First, the most significant confounding factor is the difference in the prescription rate of optimal medical therapy.…”

Section: Discussionmentioning

confidence: 99%

Determinants of Left Ventricular Systolic Function Improvement Following Coronary Artery Revascularization in Heart Failure Patients With Reduced Ejection Fraction (HFrEF)

et al. 2016

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SummaryRevascularization therapy such as percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) should be considered for heart failure with reduced ejection fraction (HFrEF). However, revascularization therapy does not always improve left ventricular ejection fraction (LVEF). The purpose of this study was to investigate the determinants of LVEF improvement following revascularization in HFrEF patients. From 2,229 consecutive decompensated heart failure patients, a total of 47 HFrEF patients who underwent revascularization were included in the analysis. Improvement of LVEF was defined as [(LVEF during chronic phase) -(LVEF during acute phase)] ≥ 10%. Univariate and multivariate logistic regression analyses were applied to investigate the determinants of LVEF improvement. The prevalence of revascularization by PCIs including chronic total occlusion (CTO) was significantly greater in the improved EF group (45.0%) as compared to the non-improved EF group (11.1%) (P = 0.02). Multivariate logistic regression analysis revealed that revascularization by PCIs including CTO was the significant determinant of the LVEF improvement after adjusting for confounding factors (OR 5.43, 95% CI 1.06-27.74, P = 0.04). Optimal medical therapy (angiotensin-converting enzyme (ACE) inhibitor and/or angiotensin II receptor blocker (ARB) and beta-blockers) was less frequently prescribed in patients with CABG (50.0% for ACE inhibitor and/or ARB and 41.7% for beta-blocker) than in patients without CABG (94.3% for both) (P < 0.01 and P < 0.001, respectively). In conclusion, revascularization by PCIs including CTO was the significant determinant of LVEF improvement in HFrEF patients. Our results underscore the importance of optimal medical therapy even if patients receive complete revascularization such as CABG. (Int Heart J 2016; 57: 565-572) Key words: Percutaneous coronary intervention, Coronary artery bypass grafting, Chronic total occlusion H eart failure is a common disease with a prevalence of 1-2% in the adult population, 1) and still has high mortality in developed countries. One-year mortality rates in population-based studies have been reported to be 25% to 45%.2-5) The mortality rate was higher in heart failure with reduced ejection fraction (HFrEF) than heart failure with preserved ejection fraction (HFpEF). 6) Mortality rates of HFrEF (ejection fraction < 50%) patients were reported to be 32% at one year and 68% at 5 years.6) The most common cause of HFrEF is coronary artery disease, which accounts for approximately two-thirds of HFrEF. 7)Revascularization therapy such as percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) should be considered in heart failure with coronary artery disease, and sometimes improves clinical outcomes including left ventricular function. [8][9][10][11][12] However, revascularization therapy is not always effective in heart failure with coronary artery disease.13) It is unknown which types of patients receive the benefits such as improvement o...

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Section: Discussionmentioning

confidence: 99%

Determinants of Left Ventricular Systolic Function Improvement Following Coronary Artery Revascularization in Heart Failure Patients With Reduced Ejection Fraction (HFrEF)

et al. 2016

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“…20,22,23,25,28,30,33,35 There was a statistically significant reduction in RR with CABG compared with PCI treatment; the respective rates were 5. …”

Section: Repeat Revascularizationmentioning

confidence: 93%

“…In a subanalysis of secondary end points, we found significantly reduced risk for MI and RR in patients treated with CABG versus PCI. 20,[22][23][24][25]30,33,35 ; (B) repeat revascularization 20,22,23,25,28,33,35 ; and (C) stroke. 20 46 and subsequent metaanalyses 47 have suggested that intermediate-term mortality after interventional revascularization using modern stent systems is comparable to CABG, with a reduced risk of stroke but a higher need for RR.…”

Section: Discussionmentioning

confidence: 99%

“…Seven studies involving 2695 patients reported a prevalence of 3-vessel disease >50% in both groups ( Figure 4B). 18,[21][22][23]28,33 The overall incidence of all-cause mortality did not differ significantly between the 2 revascularization strategies: 27.85% (379 of 1361) among patients undergoing CABG and 30.51% (407 of 1334) among patients …”

Section: Cabg Versus Pci In Patients Stratified By Disease or Treatmementioning

confidence: 99%

“…10,15,16,[18][19][20][21][22][23][24]26,[29][30][31][32][33][34][35] For the remaining 5 articles, data were abstracted from the study summaries. 8,17,25,27,28 Patient baseline characteristics are shown in Table 2.…”

Section: Study Selection and Patient Populationsmentioning

confidence: 99%

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Survival Benefits of Invasive Versus Conservative Strategies in Heart Failure in Patients With Reduced Ejection Fraction and Coronary Artery Disease

Wolff

Dimitroulis

Andreotti

et al. 2017

Circ: Heart Failure

146

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Background— Heart failure with reduced ejection fraction caused by ischemic heart disease is associated with increased morbidity and mortality. It remains unclear whether revascularization by either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) carries benefits or risks in this group of stable patients compared with medical treatment. Methods and Results— We performed a meta-analysis of available studies comparing different methods of revascularization (PCI or CABG) against each other or medical treatment in patients with coronary artery disease and left ventricular ejection fraction ≤40%. The primary outcome was all-cause mortality; myocardial infarction, revascularization, and stroke were also analyzed. Twenty-one studies involving a total of 16 191 patients were included. Compared with medical treatment, there was a significant mortality reduction with CABG (hazard ratio, 0.66; 95% confidence interval, 0.61–0.72; P <0.001) and PCI (hazard ratio, 0.73; 95% confidence interval, 0.62–0.85; P <0.001). When compared with PCI, CABG still showed a survival benefit (hazard ratio, 0.82; 95% confidence interval, 0.75–0.90; P <0.001). Conclusions— The present meta-analysis indicates that revascularization strategies are superior to medical treatment in improving survival in patients with ischemic heart disease and reduced ejection fraction. Between the 2 revascularization strategies, CABG seems more favorable compared with PCI in this particular clinical setting.

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Determinants and clinical outcomes of stroke following revascularization among patients with reduced ejection fraction

Wang

Ran²,

Cheng

et al. 2023

Brain and Behavior

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Objective Stoke after revascularization including both percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) is an uncommon but devastating complication. Patients with reduced ejection fraction (EF) had an increased risk of stroke after revascularization. However, little is known about the determinants and outcomes of stroke among patients with reduced EF following revascularization. Materials and Methods A cohort study of patients with preoperative reduced EF (≤40%) who received revascularization by either PCI or CABG between January 1, 2005 and December 31, 2014 was performed. Multivariate logistic regression was used to identify independent correlates of stroke. Logistic regression models were applied to evaluate the association of stroke with clinical outcomes. Results A total of 1937 patients were enrolled in this study. Of these, 111 (5.7%) patients suffered from stroke during the median 3.5‐year follow‐up. Older age (odds ratio [OR], 1.03; 95% CI, 1.01–1.05; p = .009), history of hypertension (OR, 1.79; 95% CI, 1.18–2.73; p = .007), and history of stroke (OR, 2.00; 95% CI, 1.19–3.36; p = .008) were found to be independent predictors for stroke. Patients with and without stroke had similar risk of all‐cause death (OR, 0.91; 95% CI, 0.59–1.41; p = .670). However, stroke was associated with higher odds ratio of heart failure (HF) hospitalization (OR, 2.77; 95% CI, 1.74–4.40; p < .001) and composite end point (OR, 1.61; 95% CI, 1.07–2.42; p = .021). Conclusions Further research appears warranted to minimize the complication of stroke and improve long‐term outcomes among patients with reduced EF who underwent such high risk revascularization procedural.

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Comparison of Five-Year Outcomes of Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention in Patients With Left Ventricular Ejection Fractions ≤50% Versus >50% (from the CREDO-Kyoto PCI/CABG Registry Cohort-2)

Cited by 61 publications

References 25 publications

Determinants of Left Ventricular Systolic Function Improvement Following Coronary Artery Revascularization in Heart Failure Patients With Reduced Ejection Fraction (HFrEF)

Determinants of Left Ventricular Systolic Function Improvement Following Coronary Artery Revascularization in Heart Failure Patients With Reduced Ejection Fraction (HFrEF)

Survival Benefits of Invasive Versus Conservative Strategies in Heart Failure in Patients With Reduced Ejection Fraction and Coronary Artery Disease

Determinants and clinical outcomes of stroke following revascularization among patients with reduced ejection fraction

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